The varicocele is not a collection of enlarged veins around the testicles. This form because of the abnormal valves which allowed backflow of blood towards the testicle. They can cause testicular pain, infertility and in some cases testicular shrinkage. Varicocele embolization is a minimally invasive, nonsurgical procedure which blocks the backflow of blood in the veins towards the testicle. This procedure only involves a small puncture in the neck or groin and has no risk of testicular injury.
A varicocele is an abnormal enlargement of the veins within the scrotum, similar to varicose veins in the legs. This condition occurs when the valves in the veins do not function properly, leading to back flow of blood into the scrotum and an increase in the size of the veins. This leads to pooling of blood around the testicles, which can increase the temperature in the testicles, leading to decreased sperm production, lower sperm quality, and in some cases, infertility or testicular shrinkage. A varicocele is a relatively common condition that tends to occur in young men, usually during the second or third decade of life. This condition affects approximately 15 to 20% of the general male population and up to 40% of infertile males.
Under normal circumstances, the blood from the testicles return to the heart through against gravity. One-way valves in these veins prevent blood from flowing backward. However, in some people, these valves do not function properly. When this happens, blood can flow in reverse towards the testicles, creating “back pressure” that causes the small veins around the testicles to stretch and enlarge, leading to the formation of a varicocele. Varicocele, similar to varicose veins are a price that we pay for our bipedal evolution! Meaning that when humans started walking on two legs and attained erect posture, the blood from the testicles had to be returned back to the heart against the force of gravity.
Thermal Regulation Issues: The primary danger of a varicocele is heat. The pooled blood in the scrotum raises the temperature of the testicles. Testicles require temperatures that are approximately 2-7°C lower than core body temperature for its optimal functioning (Reference).
Varicoceles can also cause “Low T” (Low Testosterone) as they can damage the Leydig cells due to the increase in scortal temperature. These cells are responsible for producing testosterone. Clinical studies indicate that repair through embolization can lead to a significant increase in serum testosterone levels, improving energy, libido, and muscle mass in affected men (Reference).
Embolization is typically recommended for men who have symptomatic varicoceles. Common indicators for treatment include:
Yes. Embolization is often the preferred treatment for “recurrent” varicoceles—those that return after a previous surgical repair. Because IRs use real-time X-ray (venography), they can identify small “collateral” veins that may have been missed during traditional surgery
Major guidelines (American urology Association, American Society for reproductive medicine, European Association for urology) recommend considering varicocele repair in men attempting conception who have:
(1) a clinical (palpable) varicocele,
(2) infertility, and
(3) abnormal semen parameters.
A typical workup includes a focused history and exam, semen analysis, and ultrasound imaging. In rare cases a CT scan of the abdomen and pelvis will be required.
Varicocele embolization is an image-guided procedure where an interventional radiologist inserts a catheter and blocks the vein (gonadal vein) which allows for the reversal of the blood flow towards the testicle causing varicocele. The procedure is performed on an outpatient basis, usually under “twilight” sedation and local anesthesia. A tiny nick is made in the skin—usually in the neck (jugular vein) or groin (femoral vein). A thin catheter is then threaded through the venous system to the gonadal vein. After confirming the location of the reflux using a contrast dye injection, this vein is blocked using metallic coils and a sclerosant (liquid medicine that blocks the vein). The procedure takes anywhere between 30 to 90 minutes and patients go home few hours afterwards.
Please click on the video above to see how the procedure is performed at Florida interventional Institute.
Patient is a asked not to have anything by mouth for 8 hours prior to the procedure. There is also routine labs test that needs to be completed prior to the procedure. If you are on any blood thinners, you will receive specific instructions if and when you need to stop taking them from the Florida interventional Institute staff.
Moderate (conscious) sedation is typically used. This means that we give you intravenous medicine to help you feel relaxed, calm, and comfortable during the procedure. You’ll be very drowsy, and many patients don’t remember much afterward, but you will still be breathing on your own and able to respond if we speak to you.
Access and anesthesia: Local anesthetic is used at the insertion site (commonly neck or groin).
Catheterization and imaging: Under x-ray guidance, the catheter is guided to the gonadal vein; contrast or dye injection is performed to visualize the vein and the abnormal flow.
Embolization: The vein is occluded using vein is blocked using metallic coils and a sclerosant (liquid medicine that blocks the vein).
Completion and hemostasis: A completion venogram confirms no more abnormal flow, the catheter is removed and pressure/dressing is applied.
Typically at Florida interventional Institute, jugular (neck) vein access is used. In some cases, we might use the femoral (groin) vein access is used depending on your anatomy.
The procedure can take 30 to 90 minutes, depending on the anatomy.
Yes. Large-scale studies and meta-analyses show that embolization has success rates comparable to traditional surgery, often cited between 90% and 96%. Research indicates that improvements in sperm concentration and pregnancy rates are virtually identical between the two methods (Reference).
Please do not large studies, the recurrence rate or the persistence of varicoceles after embolization is estimated to be around 5–10% (Reference). Patient’s anatomy and the method of embolization are important factors in determining the rate of recurrence.
A: A 2022 meta-analysis found endovascular treatment had lower adverse events with similar recurrence and similar pregnancy outcomes compared with surgery. (Reference)
Embolization offers several distinct advantages compared to surgical ligation:
Varicocele embolization is considered highly safe with an excellent long-term record. Overall risk with varicocele embolization is significantly lower than that of surgery. Minor risks include bruising at the entry site or mild back/flank soreness. Rare complications (less than 1%) can include migration of a coil, though modern techniques have made these extremely uncommon (PMC9767774).
Unlike surgery, where the testicular artery can be accidentally nicked or tied, embolization is performed entirely from inside the vein. This technically eliminates the risk of arterial injury and subsequent testicular loss (PMC3433543).
After the procedure, you will be given a direct number to our physician to contact in case of emergencies. The day after the procedure, you will receive a call from Florida Interventional Institute. Normally, it takes a while for the testicular functions to recover. We typically follow-up in the clinic 3 months after the procedure.
Dr Mohan has a great bedside manner and quiet confidence about him that puts you at ease. I first met him when he performed microwave ablation on my husband’s liver as part of his cancer treatment. One year later Dr Mohan did ablation laser therapy on my varicose veins.
Dr. Mohan makes the most complicated and complex surgeries easy and fun for the patient. He is very caring and has impeccable “Bedside Manners” which is most comforting for an afraid patient. Can’t wait to visit him again. Thanks.
Dr. Mohamed Saved my life! The care leading up till I got accepted for my liver transplant was nothing but the best and most professional and at times difficult. Being the cancer had to be controlled and not spread through out it was just that… he controlled it, got rid of it, explained every procedure thoroughly.
